Bouveret syndrome

Clinical presentation

Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and non-specific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients 5. Exemplifying reports of non-specific symptoms and comorbidities include synchronous acute diverticulitis 6 and complicating acute pancreatitis 7, just to name a few.

Radiographic features

Plain radiograph and CT

Rigler triad (bowel obstruction, pneumobilia, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured 4.

Ultrasound

Sonography may detect the presence of a cholecystoenteric fistula, residual gallstones and gastric outlet obstruction.

Treatment and prognosis

Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.

Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.

Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.

History and etymology

Named after Léon Bouveret, French internist (1850-1929), the sign was originally described by him in 1896 . However it was actually originally described by Beaussier in 1770 8.

Practical points

a preceding history of gallstone disease will only be present in a minority of cases 5,6